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Yes, after all these years of writing about EMRs, EHRs, PHRs, patient portals and the like, I have had my first real personal experience with a patient portal, courtesy of my internist.

He still has a small practice, with four other physicians, including one fresh out of residency. Those small practices are a dying breed, but this doctor is changing with the times, too. He recently offered a concierge option for a few hundred patients. I declined because I don’t need to reach him that urgently.

The portal has been in place for a couple of years, and I may have logged in once or twice before to set up an account, but didn’t really do anything other than look around. This time, prompted by an e-mail informing me of a new URL, I logged in and checked my medication list. I remembered that another doctor had changed the dosage of one of my medications a while back, so I fired off a secure message informing this practice of the change. (It was a new URL presumably because the EHR vendor formerly known as Sage Healthcare adopted the Vitera Healthcare Solutions name a year ago and was switching its customers to a common, white-labeled portal.)

I also looked at some of my test results from a year and a half ago just to confirm that everything was more or less OK then, though I did see one abnormality with my HDL cholesterol. I last went for a physical in March 2011, about a month after I ungracefully cut my face open on a bathtub in Orlando during HIMSS11, so I was probably due. This practice lets patients request appointments — not actually choose open slots — online, so I sent my request. Tonight, about 24 hours later, I got my confirmation, and I’ll be seeing the doc in a couple of weeks.

It’s not a perfect system, but it was convenient enough for a night owl like myself who might not remember to call during business hours to make an appointment or simply not want to wait on hold or press a bunch of buttons to navigate a telephone menu. I did not see the Blue Button option to download my record that the federal government is pushing private vendors to adopt, but I’m sure that will be there by the time the practice is ready for “meaningful use” Stage 2 in a year or two. I don’t have a PHR anyway, so I wouldn’t be able to do anything with the data other than print it.

I suppose I should set up an emergency PHR at some point, even though I doubt any hospital or specialist I might get referred to would take the time to download my data from a USB drive or log into someone else’s portal. Untethered PHRs simply don’t fit physician workflow. That might change in MU Stage 2 when providers will have to send electronic discharge statements and patient summaries during transitions of care, but I’m still not convinced a patient-controlled PHR will be the right vehicle for these data transfers.

I went back to the doctor this week for a routine checkup and found that some progress had been made. For one thing, my own doctor charted the encounter electronically. And, much to my pleasant surprise, the practice had started up a patient portal. I discuss my experience with the portal in FierceEMR today.

As a side note, a practice manager from, of all places, Guam, recently contacted me about the original blog post, wanting for me to get him in touch with the practice I wrote about because he was considering the same Sage Intergy system. I was happy to oblige, as was the office manager of my physicians’ practice.

I canceled my last vendor meeting at HIMSS09 yesterday so I could make a last-minute doctor’s appointment at 1:15 p.m. (ah, the joys of not having to travel for a major conference). As it turned out, I slogged through most of HIMSS with bronchitis. I hope I didn’t get anyone else sick.

My regular internist is not in this particular office on Wednesdays, so I was seen by another partner in the five-physician primary care practice—the most tech-savvy one. The entire patient-physician encounter lasted the usual 10 minutes, but I got a wonderful demonstration in that short time of the issues facing so many practices.

The doctor pulled up my record on the Sage Intergy EMR that the practice has had for the last three years (a replacement for an earlier system), but couldn’t find much of a history on me. I had given my regular physician a printed list of my medications and allergies the last time I was in there for a checkup last year, but that never got into my electronic chart. No matter, this doctor took my information verbally, and typed everything in as I was talking to him. (I checked, and it was accurate.)

He examined me, entered the diagnosis into the EMR and gave me some simple, verbal instructions, since he didn’t write any prescriptions for this encounter. (Even I know that antibiotics are ineffective against viral bronchitis, so I picked up some OTC medicine for sore throat and cough at a local Walgreens.)

I was surprised my history hadn’t gotten into the record, but this doctor was not. He is what you could call an early adopter, having been convinced to go electronic a decade ago. He said he’s been fighting his partners for years to get them to use the EMR for more than just entering orders and diagnoses. He said he loves the Intergy system, which should make the folks in Tampa smile, but wishes he could persuade the other doctors to do more and make a larger investment.

This practice has spent $120,000 over the past three years on the EMR, but needs another $50,000 to integrate or upgrade the practice management system so the two sides could share demographic and insurance data, making the whole operation more efficient. Unfortunately, the other doctors don’t want to spend the extra money while primary care is under so much financial pressure. Until there is the link between practice management and EMR, the practice isn’t even able to report its activity to capture the new 2% Medicare bonus for e-prescribing, the doctor said.

All the stimulus money sounds exciting for those of us who view health IT from on high, but January 2011 might as well be an eternity from now for those on the front lines of medicine.

OJAI, Calif.—I’m at the Physician-Computer Connection, the annual symposium of the Association of Medical Directors of Information Systems (AMDIS), a high-level meeting of chief medical information officers and other leading medical informatics specialists. I’ll have a bunch on a couple of surveys on the attitudes, job functions and salary ranges of CMIOs and physician executives in IT, most likely in Digital HealthCare & Productivity in the next couple of weeks. (I need to pay for this trip, after all, and the recent run-ups in airfares, car rental costs and, of course, gasoline, are not helping my cause. But I digress.) Let’s just say a need for leadership skills is prominent.

I have plenty of other news and notes that are worthy of posting here, however.

For one, look out this fall for “Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-step Guide,” an update to the 2005 “Improving Outcomes with Clinical Decision Support: An Implementer’s Guide.” According to lead author Jerry Osheroff, M.D., chief clinical informatics officer of Thomson Reuters Healthcare (formerly Micromedex), this one defines CDS as “providing clinicians or patients with clinical knowledge and patient-related information, intelligently filtered or presented at appropriate times, to enhance patient care.” The guide will follow a modified set of the “five rights” for safe healthcare: The right information to the right person in the right intervention format through the right channel at the right point in the workflow, Osheroff says.

Contrary to rumors, healthcare executive recruiter Betsy Hersher is not retiring, but she is shutting down her Hersher Associates firm and moving into consulting. At least a couple of her employees have taken jobs at Witt/Kieffer.

Earlier this week, I reported in Digital HealthCare & Productivity about the recent reorganization at Sage Software Healthcare. I since have learned that the company will be hiring a new, permanent CEO sooner rather than later. I’m guessing that means within a few weeks. I have no idea about who the candidates might be.

While I’ve been out here on the West Coast, the Medical Records Institute published a scathing critique of the national EMR strategy. That organization is working hard to market itself and stay relevant after a poorly attended TEPR conference a couple of months ago. This article certainly is an attention-grabber, listing the optimism about meeting the goal of getting interoperable EHRs to most Americans by 2014 among a number of “health informatics myths.”

If you want an impassioned defense of the national health IT strategy, check this space in the next 24 hours for my podcast with national health IT coordinator Robert Kolodner, M.D., who spoke at this conference yesterday. This might be my biggest podcast “get” to date.

Free Healthcare IT Newsletter Want to receive the latest news on EMR, Meaningful Use,
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